Individual
KHESON KABALLA MADISON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
555 W GRAND AVE, WISCONSIN RAPIDS, WI 54495-2784
(715) 424-4682
(715) 424-4614
Mailing address
555 W GRAND AVE, WISCONSIN RAPIDS, WI 54495-2784
(715) 424-4682
(715) 424-4614
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
2403-19
WI
Other
Enumeration date
10/04/2017
Last updated
10/04/2017
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